[Scoliosis surgery in patients with myelomeningocele]. / Cirugía de escoliosis en pacientes con mielomeningocele.

OBJECTIVE: The aim of the study was to evaluate the outcomes and complications in patients with myelomeningocele who have undergone spinal fusion for neuromuscular scoliosis. MATERIAL AND METHODS: Retrospective study of 40 consecutive patients with myelomeningocele with neuromuscular scoliosis who underwent spinal arthrodesis, treated at our center between July 1991 and July 2028. RESULTS: Mean follow up was 10 years. There were 19 male and 21 females. The average age at operation was 13 years. The mean preoperative scoliosis curve was 90o. At last follow up, the mean scoliosis curve was 43o. Mean correction of 52%. The average of pelvic obliquity was 19o. At last follow up de obliquity was 9o. Mean correction of 53%. The mean preoperative coronal balance was 28.4 mm. At the last follow up it was 17 mm. Mean correction of 40%. The mean preoperative kyphosis was 50o. At the last follow up it was 41o. Mean correction of 18%. The mean preoperative sagittal balance was 63.3 mm. At the last follow up it was 38.3 mm. Mean correction of 40%. There were 13 complications (32.5%), with infection being the most frequently observed complication. CONCLUSIONS: The goals of the spinal surgery in patients with MMC are to obtain a stable, balanced and painless spinal fusion. Although the surgical treatment of these patients remains difficult, it is associated with high complication rate.

OBJETIVO: Evaluar en forma retrospectiva los resultados obtenidos y las complicaciones presentadas en el tratamiento quirúrgico de pacientes con escoliosis neuropática secundaria a mielomeningocele. MATERIAL Y MÉTODOS: Entre Julio de 1991 y Julio de 2018 fueron tratados quirúrgicamente 40 pacientes consecutivos con diagnóstico de escoliosis neuropática secundaria a mielomeningocele, a quienes se les realizó artrodesis vertebral. RESULTADOS: El promedio de observación fue de 10 años (rango de 2-27 años). Fueron 19 pacientes masculinos y 21 femeninos, con un promedio de edad de 13 años. La magnitud promedio de la curva escoliótica fue de 90o en el prequirúrgico y de 43o en el último control. Corrección promedio de 52%. La magnitud promedio de la oblicuidad pélvica fue de 19o en el prequirúrgico y de 9o en el último control. Corrección promedio de 53%. La magnitud preoperativa del balance coronal fue de 28.4 mm, al último control fue de 17 mm. Corrección promedio de 40%. La magnitud promedio de la cifosis fue de 50o en el prequirúrgico y de 41o en el último control. Corrección promedio de 18%. El balance sagital prequirúrgico fue de 63.3 mm, al último control fue de 38.3 mm. Corrección promedio de 40%. Hubo 13 complicaciones (32.5%), la infección fue la complicación observada con mayor frecuencia. CONCLUSIÓN: Los principales objetivos de la estabilización quirúrgica en pacientes con mielomeningocele son obtener una columna estable, balanceada y sin dolor. Sin embargo, el tratamiento quirúrgico de estos pacientes continúa siendo difícil y está asociado a un alto porcentaje de complicaciones.

Effects of manganese on carcinogenicity and metabolism of nickel subsulfide.

Nickel subsulfide, Ni3S2, alone or combined with manganese or chromium dusts, was administered i.m. to Fischer rats to study the effects of the metals upon Ni3S2 induction of sarcomas at the injection site. The incidence of sarcomas within 2 years after injection of Ni3S2 (1.2 mg) plus manganese (1.0 mg) was 7%, versus 77% in rats that received only Ni3S2 (1.2 mg), and 80% in rats that received Ni3S2 (1.2 mg) plus chromium (1.0 mg) (p less than 0.005). No local sarcomas occurred in rats that received the injection vehicle, or in rats that received manganese or chromium without Ni3S2. Admixture of manganese diminished the solubility of 63Ni3S2 in rat serum, serum ultrafiltrate, or water, in vitro. Admixture of manganese with 63Ni3S2 did not affect the mobilization or excretion of 63Ni in vivo, nor did it alter the acute pathological reactions to Ni3S2. 63Ni concentrations in ultrafiltrates of supernatant fractions of homogenates of injection sites averaged 2.8 (S. D. +/- 0.7) ng/ml at 5 to 6 months after injection of 63Ni3S2 (1.2 mg) plus manganese (1.0 mg), versus 5.4 +/- 2.0 ng/ml after injection of only 63Ni3S2 (1.2 mg) (p less than 0.02). This study demonstrates that admixture of manganese dust and Ni3S2 inhibits Ni3S2 tumorigenesis in rats, and reveals that manganese dust affects the subcellular distribution of 63Ni derived from 63Ni3S2, without influencing 63Ni kinetics as estimated by compartmental analysis.

Cirugía de escoliosis en pacientes con mielomeningocele / Scoliosis surgery in patients with myelomeningocele

Resumen: Objetivo: Evaluar en forma retrospectiva los resultados obtenidos y las complicaciones presentadas en el tratamiento quirúrgico de pacientes con escoliosis neuropática secundaria a mielomeningocele. Material y métodos: Entre Julio de 1991 y Julio de 2018 fueron tratados quirúrgicamente 40 pacientes consecutivos con diagnóstico de escoliosis neuropática secundaria a mielomeningocele, a quienes se les realizó artrodesis vertebral. Resultados: El promedio de observación fue de 10 años (rango de 2-27 años). Fueron 19 pacientes masculinos y 21 femeninos, con un promedio de edad de 13 años. La magnitud promedio de la curva escoliótica fue de 90o en el prequirúrgico y de 43o en el último control. Corrección promedio de 52%. La magnitud promedio de la oblicuidad pélvica fue de 19o en el prequirúrgico y de 9o en el último control. Corrección promedio de 53%. La magnitud preoperativa del balance coronal fue de 28.4 mm, al último control fue de 17 mm. Corrección promedio de 40%. La magnitud promedio de la cifosis fue de 50o en el prequirúrgico y de 41o en el último control. Corrección promedio de 18%. El balance sagital prequirúrgico fue de 63.3 mm, al último control fue de 38.3 mm. Corrección promedio de 40%. Hubo 13 complicaciones (32.5%), la infección fue la complicación observada con mayor frecuencia. Conclusión: Los principales objetivos de la estabilización quirúrgica en pacientes con mielomeningocele son obtener una columna estable, balanceada y sin dolor. Sin embargo, el tratamiento quirúrgico de estos pacientes continúa siendo difícil y está asociado a un alto porcentaje de complicaciones.

Abstract: Objective: The aim of the study was to evaluate the outcomes and complications in patients with myelomeningocele who have undergone spinal fusion for neuromuscular scoliosis. Material and methods: Retrospective study of 40 consecutive patients with myelomeningocele with neuromuscular scoliosis who underwent spinal arthrodesis, treated at our center between July 1991 and July 2028. Results: Mean follow up was 10 years. There were 19 male and 21 females. The average age at operation was 13 years. The mean preoperative scoliosis curve was 90o. At last follow up, the mean scoliosis curve was 43o. Mean correction of 52%. The average of pelvic obliquity was 19o. At last follow up de obliquity was 9o. Mean correction of 53%. The mean preoperative coronal balance was 28.4 mm. At the last follow up it was 17 mm. Mean correction of 40%. The mean preoperative kyphosis was 50o. At the last follow up it was 41o. Mean correction of 18%. The mean preoperative sagittal balance was 63.3 mm. At the last follow up it was 38.3 mm. Mean correction of 40%. There were 13 complications (32.5%), with infection being the most frequently observed complication. Conclusions: The goals of the spinal surgery in patients with MMC are to obtain a stable, balanced and painless spinal fusion. Although the surgical treatment of these patients remains difficult, it is associated with high complication rate.

Malformation of bronchopulmonary foregut with systemic and pulmonary arterial blood supply.

A case of congenital malformation of the bronchopulmonary foregut with communication between the esophagus and sequestered lobe is reported in a six-month-old boy. Only 29 similar cases have been reported previously, and this case was especially unusual in that the communication was from the middle portion of the esophagus to a right apical sequestration. Another unusual feature was that the sequestered segment was supplied by four systemic arteries from the thoracic aorta, as well as by branches from the right pulmonary artery. Within the sequestration, there was shunting of blood from the systemic to pulmonary arterties with reversal of flow in the pulmonary arterial branches.

Müllerian adenosarcoma of the uterus. Ultrastructure before and after radiation therapy.

A case of müllerian adenosarcoma arising in the endometrium was studied by light and electron microscopy before and after radiation treatment. The tumor was composed of malignant stroma containing undifferentiated mesenchymal cells admixed with mature fibroblasts and other cell that contained crystalloids. The surface epithelium was lined by epithelial cells with and without cilia, similar to the normal surface epithelium cells of the uterus. High-dose therapeutic irradiation eliminated the undifferentiated mesenchymal cells from the tumor but did not alter the morphology of other epithelial and mesenchymal elements. The immaturity of mesenchymal cells and their radiosensitivity coupled with the ultrasonographic evidence of growth of the tumor point to the probable malignant nature of this neoplasm.

Comparison of polyglactic and polyglycolic acid sutures in reproductive tissue.

Polyglactic acid and polyglycolic acid suture materials were compared in rat uterine and abdominal wall tissues for inflammatory response and tissue fibrosis. By 90 days after surgery, the tissue inflammatory reaction and fibrosis were significantly less in response to polyglactic acid suture (Vicryl) in both uterus and skin as compared with the response to polyglycolic acid (Dexon). In addition, the over-all tissue response in skin was significantly greater than that in uterus for both suture materials. The potential importance of tissue fibrosis--particularly in oviductal surgery, over and above the formation of adhesions between one organ and another--is emphasized. It is concluded that (1) the magnitude of tissue response to suture material varies for different tissues, (2) the degree of tissue wall fibrosis does not necessarily correspond to external tissue adhesions, (3) adhesions are maximal at the surgical knots regardless of the suture material used, and (4) polyglactic acid suture material may be preferable to polyglycolic acid suture material for infertility surgery, in which a minimum of tissue reaction is imperative.

A comparison of thermal injury, healing patterns, and postoperative adhesion formation following CO2 laser and electromicrosurgery.

To further define the role of CO2 laser in infertility surgery, the authors compared the immediate tissue damage and the subsequent healing patterns that followed the randomized use of CO2 laser and electrocautery on opposite sides of the reproductive tracts of 20 mature, female rabbits. Blind histopathologic evaluations were performed on the ovarian and uterine tissues immediately to compare the extent of the acute thermal damage, and 4 weeks postoperatively to compare the healing patterns. There were no differences in the depth of thermal damage, extent of collagen deposition, or in postoperative adhesion formation between CO2 laser and electrocautery. However, the mean depth of the acute thermal damage was significantly less on the ovary than on the uterus, and the area of fibrosis was significantly less when the incised uterine surfaces were approximated.

Carcinogenicity of nickel subsulfide in Fischer rats and Syrian hamsters after administration by various routes.

In an endeavor to expand the variety of experimental models for study of nickel carcinogenesis, nickel subsulfide (Ni3S2) was administered to rodents by five previously untested routes. In two groups of Syrian hamsters, Ni3S2 induced multiple sarcomas at the sites of single im injections (5 or 10 mg of Ni3S2). In contrast, Ni3S2 did not induce any malignant tumors of the cheek pouches, oral cavity or gastrointestinal tract, despite multiple local applications to the cheek pouches of several groups of hamsters in total dosages as large as 1.1 g of Ni3S2. In a group of Fischer rats, single intratesticular injections of Ni3S2 (10 mg) induced many testicular sarcomas. In contrast, no malignant tumors developed in two groups of rats that received single injections into the submaxillary gland (2.5 mg of Ni3S2) or into the liver (5 mg of Ni3S2 via the portal venous system).

Comparisons of carcinogenicities of nickel compounds in rats.

This study demonstrates marked differences in the incidences of sarcomas in Fischer rats within 2 years after a single im injection of 4 insoluble nickel-containing powders: amorphous nickel monosulfide (NiS), nickel subsulfide (alphaNi3S2), partially converted nickel-iron sulfide matte, and metallic nickel. The powders (less than 2 um median particle diameters) were administered in penicillin suspension, and each powder was tested at 2 dosages. Whereas alphaNi3S2 was highly carcinogenic, amorphous NiS did not induce any tumors. The carcinogenic potency of partially converted nickel-iron sulfide matte was less than alphaNi3S2 but greater than Ni powder. No sarcomas occurred at the injection site in two groups of control rats that received im injections of penicillin or Fe powder. The observed differences in carcinogenic potencies of alphaNi3S2 and amorphous NiS may provide an experimental approach to elucidate the molecular mechanisms of nickel carcinogenesis.

The myth of the fecalith.

A radiographically demonstrated fecalith is widely considered a virtually pathognomonic sign of acute appendicitis. This case report describes a patient with a clinical presentation suggestive of appendicitis and a well-defined right lower quadrant fecalith who was found to have a normal appendix at surgery. This case calls into question the venerable dogma surrounding the fecalith and highlights the necessity for the physician to continue to rely on clinical judgment in making the diagnosis of appendicitis.

A meta-analysis of blunt cardiac trauma: ending myocardial confusion.

The purpose of this study was to use a meta-analysis of the current literature to identify which patients with blunt cardiac trauma develop complications. All studies on myocardial contusion since 1967 were reviewed. Three separate meta-analyses were performed: one with only prospective studies, one with only retrospective studies, and one with all studies combined. Data on electrocardiogram (ECG), creatine phosphokinase-MB isoenzyme (CPK-MB), radionuclide scans, and echocardiogram were analyzed using the Mantel-Haenszel procedure. Results of the three meta-analyses were similar. Abnormal ECG and abnormal CPK-MB were found to correlate directly with complications requiring treatment. Conversely, normal ECG and CPK-MB correlated with the lack of clinically significant complications. Radionuclide scans did not correlate with complications. The results for echocardiogram were not congruent between the prospective and retrospective studies. The data support the use of ECG and CPK-MB in the diagnosis of clinically significant myocardial contusion. Radionuclide scanning is not useful in the evaluation of patients with blunt cardiac trauma. Further studies need to define the role of echocardiography.

Monoclonal antibody DF3 correlates with tumor differentiation and hormone receptor status in breast cancer patients.

The murine monoclonal antibody (MAb) designated DF3, reacts with a 300-kd human mammary epithelial antigen which is expressed on apical borders of secretory mammary epithelial cells and in the cytosol of less differentiated malignant cells. Human mammary tumors have been evaluated for the level of DF3 antigen as a correlate to clinicopathologic parameters related to degree of tumor differentiation: nuclear grade (NG), histologic grade (HG), and estrogen receptor status (ER). More DF3 antigen was present in breast carcinomas with NG 1 and 2 as compared to tumors with NG 3 (p = .002). Similarly DF3 antigen presence was greater in HG 1 and 2 tumors than in HG 3 (p less than .001). The results also demonstrate that quantitative differences in the presence of the DF3 differentiation antigen correlate with estrogen receptor status. Twenty-two of 23 ER positive tumors were also DF3 positive. Only 6 of 23 ER negative tumors were reactive to MAb DF3 (p less than .001). There was, however, no correlation between DF3 reactivity and absolute levels of estrogen or progesterone receptor. These findings confirm our hypothesis that MAb DF3 reacts to a differentiation antigen present in some human breast carcinomas. The DF3 antigen phenotype can serve as an independent phenotypic marker with correlations to standard indicators of degree of differentiation and estrogen receptor status of infiltrating ductal carcinomas of the breast, and should thus be evaluated as a prognostic indicator in breast cancer patients. The data also suggests that DF3 histochemistry may be a useful alternative in assessing estrogen receptor status of small breast cancers where there is an insufficient amount of tumor present for biochemical assay of hormone receptor levels.

Congenital aggressive lipomatosis.

Three cases of congenital lipomatosis involving the thoracic region posteriorly are presented delineating the natural history of the disease and depicting underlying bone and soft tissue changes. The rib widening and pleural thickening appear to be related to increased intercostal vascularity feeding the overlying tumor, as delineated by angiography. This entity is not described in the radiologic literature.

Yersinia colitis.

A 2-year-old child with a febrile, non-bloody diarrheal illness of acute onset with repeatedly negative stool and blood cultures for pathogenic bacteria is presented. Sigmoidoscopic and roentgenographic studies revealed an inflammatory colitis. Unfortunately, diagnostic perserverance and a high index of suspicion resulted in a positive stool culture for Yersinia enterocolitica. Serologic study and clinical course provided data consistent with the diagnosis of an infectious colitis due to Yersinia enterocolitica. This case demonstrates the necessity to consider Yersinia enterocolitica in the radiographic differential diagnosis of Crohn's disease of the colon or ulcerative colitis, as well as intractable diarrhea of childhood.

Juvenile ossifying fibroma: an ultrastructural study.

The ultrastructural features of a juvenile ossifying fibroma of the maxilla are described. The stromal portion of the tumor was composed of osteoblasts and to a lesser extent of fibroblasts. The bone spicules were rimmed by osteoblasts and osteoclasts. Calcification was seen to occur along the collagen fiber matrix, corresponding to calcification of osteoid, and also in the form of intracellular and extracellular crystallization. The latter form of calcification corresponded to so-called psammoma-like bodies, and was considered characteristic of this subtype of ossifying fibroma.